Job Summary: The Senior Director, Clinical Data Governance & Integration is responsible for developing, executing and coordinating enterprise clinical data governance and integration activities. This role ensures standardized business requirements, oversees governance cadence, and drives cross-functional alignment across
Job Summary: The Director, Pharmacy Clinical Strategy leads the strategic development of formulary management best practices & industry-leading, market-competitive formulary and medical drug strategies across all CareSource lines of business and markets. Essential Functions: Ensures the
Overview Versiti is a fusion of donors, scientific curiosity, and precision medicine that recognize the gifts of blood and life are precious. We are home to the world-renowned Blood Research Institute, we enable life saving gifts
Job Summary: The Provider Contracting Analyst II supports the development, validation, and optimization of provider reimbursement strategies through advanced data analysis, financial modeling, and AI-enabled analytic tools. This role is responsible for evaluating provider payment methodologies, conducting
Job Summary: The Quality Risk Adjustment Advisor IV is responsible for leading key components of the Quality Risk Adjustment (QRA) programs, including prospective programs, chart retrieval and coding processes, while ensuring compliance with regulatory standards and
Job Summary: The Business Analyst IV is a senior-level position responsible for driving strategic initiatives and leading cross-functional teams to deliver innovative solutions that address complex business challenges. This role bridges the gap between business needs
Job Summary: The Clinical Appeals Medical Director will perform medical necessity review of appeals, within the organization, ensuring timely, accurate, quality and compliant review of clinical appeals. Administers the decision-making process related to appeals, supports clinical
Manager, Information Technology – Encounters IT (Transformation & Architecture Focus) Job Summary The Manager, Information Technology – Encounters IT is a technology leader and visionary responsible for driving modernization, scalability, and innovation across the Encounter Management
Job Summary: The Market Behavioral Health Medical Director is responsible for the overall safety of patients with a Behavioral Health diagnosis, with a special focus on safe prescribing. Essential Functions: Assume responsibility for the overall safety
Job Summary: Vice President, Actuarial - Product is responsible for driving company strategy and managing actuarial expertise in coordination with other leaders on all aspects of CareSource’s rate levels to ensure actuarial soundness, and to use
Looking for a flexible work schedule and an opportunity to earn extra income with room for growth? Prefer working outdoors instead of being stuck inside? This could be the perfect fit for you. Field Audit &
Job Summary: The Managing Actuary provides leadership and direction to ensure team goals and strategies are successfully achieved. Essential Functions: Responsible for pricing, forecasting, reserving or other actuarial processes including development of key assumptions, as well
Job Summary: The Operations Specialist II provides analytical support and leadership for project impacting Claims and key internal Claims projects. Essential Functions: Represent claims on cross-functional project work teams Submit, monitor and prioritize IT tickets for
Job Summary: The Program Integrity Medical Coding Reviewer II is responsible for review of medical record audit activities, dispute support as needed, medical records work queues as well as claim reviews for provider pre-payment and post-payment
Job Summary: The Scrum Master II is responsible for guiding and coaching the Scrum Team and organization on how to use Agile/Scrum practices and values. Essential Functions: Guide and coach the Scrum Team and organization on
Requisition Number: 29268 Required Travel: 0 - 10% Employment Type: Full Time/Salaried/Exempt Anticipated Salary Range: $58,877.00 - $85,000.00 Security Clearance: None Level of Experience: Mid This opportunity resides with Warfare Systems (WS), a business group within HII’s
Job Summary: The Behavioral Health Medical Director is responsible for the overall safety of patients with a BH diagnosis, with a special focus on safe prescribing. Essential Functions: Assume responsibility for the overall safety of patients
Job Summary: The Clinical Psychologist provides Behavioral Health coverage determination for utilization management to ensure members receive appropriate and medically necessary care in the most cost-effective setting. Essential Functions: Assume responsibility for the overall safety of
Job Summary: The Team Lead, Program Integrity drives and encourages innovative investigative processes and workflows to reduce turnaround time and produce positive investigative outcomes. Essential Functions: Direct the day-to-day activities and leadership of investigative staff to